South Central VA Health Care Network (VISN 16)

Issue: Three documents were found unattended in the parking lot of the VA Medical Center by VA Police. The documents were clinic appointment lists for a specific provider. The clinic appointment list did not contain any diagnosis however contained the following:…

Outcome: The employee required to retake privacy training and to ensure documentation containing PHI will be discarded in accordance to station policy andrecords management program for disposing by shredding unnecessary documentation.

Issue: Five VA employees accessed medical records of two other VA employees whom were involved with a death and arrest. VA Network and Vista Access have been disabled by OI&T for the five VA Employees pending investigation. Update: 11/04/11:One of the…

Outcome: Human Resources Management Service has taken actions against violators and credit monitoring letters have been sent out.

Issue: Veteran A reported to the facility to report that he had received copies of medical records for Veteran B. The medical records included the full SSN and medical information including diagnosis, medications, and lab results. Update: 11/01/11:Veteran B will be…

Outcome: Employee acknowledged that he got the packets mixed up when he was mailing them out. He has been counseled and is aware of the training and awareness issued. Documents were returned to VA control today 10/31/2011.…

Issue: A VA Social Work Provider is in the same faith group with a Veteran according to a report from another Social Worker. The Social Work Provider announced in a open group forum (15 people) that he was treating the Veteran.…

Outcome: Employee received written counseling.

Issue: While transporting some Beneficiary Travel documents from the cashiers cage to the Allergy Clinic, the employee fell outside of the Medical Center. In doing so, the employee dropped the documents and has been unable to find one of them. This…

Outcome: Information will be transported in a zipped and locked bag. All employees were educated on the new procedure.…

Issue: Veteran A called to report that when he received his appointment letter in the mail, there were two other appointment letters for Veterans B and C in the envelope with his. The letter contained full ssn, full name, and addresss…

Outcome: Supervisor counseled MSA clerk being more careful when stuffing envelopes.

Issue: On 10/21/11, the patient advocate received a phone call from an individual that stated they had received a 19 page fax containing health information of a Veteran. The individual also contacted the Veteran. The Veteran asked the caller to shred…

Outcome: Staff were educated on the need to verify fax number with intended receiver and to validate receipt with a follow-up telephone call.

Issue: Nurse that makes calls to patients after their discharge was talking to Veteran A when Veteran A saw they had received different medications. Veteran A looked and saw the medications belonged to Veteran B. The Privacy Officer (PO) called the…

Outcome: Periodic monitoring will be completed by supervisor for 3 months by reviewing completed patient orders ready for pick up. Additional refresher training is provided to staff. Letter will go out as soon as signed by Director. As stated..monitoring in place.…

Issue: A Patient Account Services (PAS) employee called Veteran A regarding an authorization for billing that was needed. During the course of the conversation the Veteran told the PAS employee that his BCBS insurance had been billed in error by a…

Outcome: Employee was educated by supervisor and appropriate administrative action has been taken.

Issue: Received an email from an employee with the VA Health Resource Center (HRC) who said a citizen notified her that she was receiving mail from the VA for a Veteran who use to live next door to her. Said she…

Outcome: In the documentation provided by the individual who received the mail she states that the Veteran was aware before he moved that some of his mail was coming to her address and he needed make the appropriate notifications of an…